Oral Rehydration Therapy Should be Taught in Schools

Afable Medical Center – I became flustered as I heard one of the mothers say “No” when asked whether she gave Oresol (an old brand and short name for Oral Rehydrating Salts) to her child who had 3 days of watery diarrhea. I really tought they teach this at the grade school level as I was taught in Las Pinas about Oresol during grade 2. I poked around the history and found that the mother received primary education but was never taught how to prepare ORS. I apologized for my behavior and realized that I was lucky enough that I knew how to prepare ORS at a young age. Most people aren’t and I shouldn’t be judgemental.

I didn’t grow up rich but I did attend a private school. It was the cheapest private school at that time. My mother had to make ends meet just to pay the tuition and I had to be a good student just to stay at that school. I think I taught my mother ORS. It was simple. Just drop the tablet, shake it, drink it and you’ll feel better. No dosing, just drink when you have diarrhea or vomiting. I learned it can be bought without a prescription since our Home Economics teacher made us buy one as an assignment.

Related Story: Mom’s Best Arsenal Against Diarrhea: Oral Rehydration Salts!

It’s a simple remedy that stays in the mind once taught and sticks once practiced. Although as a doctor, I prescribe it with more on dosage control to effectively put out dehydration but as an educator, I think what my school has done for me during grade school should be practiced in all private and public K-12 schools. The information can help save lives since Oral rehydration solutions should be administered promptly especially to kids less than five years of age to prevent death.

Fact: In the Philippines, most teenagers who became pregnant early are grade-school or high school drop outs. Due to poverty, dropping out can’t be helped especially in urban areas. Poverty in rural areas is different in highly urbanized cities. Cost of living is higher in urban areas and places strain on both parents and students. If health maintenance education like Oral Rehydration Therapy can be taught early in school, we can target this population effectively and prevent more under-five deaths.

But this grade-schoolers aren’t five years old or below, you might ask. Yup, but they are future parents.

Related Story: Gatorade in Diarrhea: not First Line therapy

Fact: ORS overdose especially in diarrhea is rare or probably nonexistent. I haven’t encountered one and I would be able to spot it since I’m a doctor. Free and cheap ORS (even the flavored ones) are hard to swallow because of the taste. Glucose found in ORS isn’t sweet. As an experiment, I have attempted to swallow 500ml of it as fast as I could and ended up vomiting it. We can only take a few amounts of it at one time. Letting the child sip it, placing it in droppers, or using teaspoons to administer it is safe. It only takes a little to create clinical improvement. It is safe in all situations.

Theoretically, an overdose can only happen if the child suffers different morbidities. At that time, the child would probably have been admitted for other reasons that would not preclude the use of ORS.
Teaching a child how to treat himself/herself using ORS is as easy as drop, shake, and sip. No need for a thorough explanation.

If symptoms persist, consult your doctor. We can then give more thorough instructions depending on weight and dehydration severity. Other measures can then be initiated but we can be assured that once ORS was started at home, the patient is likely to be away from danger.

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Aspirin Should Not Be Stopped Perioperatively, from Medscape

Olongapo City, Philippines by Zero Mella MD — It’s still a popular belief of IM consultants that aspirin should be stopped 7 to 9 days before surgery. The belief is that it may cause increase bleeding risk especially in major abdominal surgeries. Some old cardiologists still adhere from this belief. A medscape article tells us that they may be doing more harm than good.

A phenomenon termed aspirin withdrawal effect causes platelet rebound and prothrombosis which could lead to a cardiovascular event with a mean onset at 11 days from stopping the aspirin.

Continue reading

Trust your doctors: ethical dilemmas in remote medical consults

A 35 year-old female came in at Afable Medical Center, with severe 10/10 (NAS) hypogastric pain of sudden duration. Palpation revealed a tender abdomen to deep palapation at the left lower quadrant. There was no fever and no relief to Mefenamic Acid, an over the counter analgesic.

Initial Assesment was a possible Nephrolithiasis. CBC and Urinalysis were normal except for 2-4 WBC on the urine sample. No crystals were seen. Tramadol and Buscopan per IV were given to the patient with substantial relief. Admission was offered for observation and to prep for an ultrasound. A referral to a urologist was recommended.

Related Story: Warning: Bioflu should not be used every 4 hours!!!

The patient agreed and was admitted.

It was a Sunday and, since Olongapo City was short of medical practitioners, I had to wait for an available urologist to examine my patient. For temporizing measure, I gave Tramadol and Cefuroxime (a broad spectrum antibiotic). I also have to wait until a sonologist would have to be available for an ultrasound.

All my management was sound and under protocol.

After a few hours, she bursts out in anger.

“Uuwi na po ako; wala daw po ako sakit. [Trans. I’m going home, they told me I have no illness]

“Who told you?” I asked.

She gave me her cellphone and I talked to a Dermatologist who was very angry that I admitted her sister-in-law with 2-4 WBC.

I told her that I saw the patient in severe pain and that she had to undertake more tests.

She told me that I was an ingrate and that I know nothing about her sister-in-law’s condition.

She dropped the phone. I asked my patient for the doctor’s name and she refused. She paid for the bill after signing a HAMA agreement.

This was four years ago and I regret I did not sue. The attending physician, or the one that is actually present, has precedence over a medical case. Medical opinions outside of the case are just that, medical opinions. Having a board certified specialty training in Dermatology doesn’t make you an expert over matters you cannot see. You can have a triple specialty or subspecialty but if you do not oversee the case, you shouldn’t make inferences that can damage the reputation of the attending.

The dermatologist violated the PMA Code of Ethics and is liable for slander. My story is one of many I have encountered in clinical practice. I have met patients time after time asking for a second opinion hoping to discredit the previous doctor in their care. I always tell the patients about differences in practices and that their previous doctor was doing the best he can. I do not wish to stain anybody’s reputation but time after time, I hear my own patients telling me that some specialty consultant said something bad about me, or that another patient I knew, is spreading a nasty rumor after his/her kid is not feeling well despite the meds I gave. Each of us doctors graduated with a degree of Medicine and sworn to uphold an oath. Each one had a different set of teachers and a different set of values. In a time when teamwork is needed, I see a crab-mentality issue going on.

“Hindi yan magaling… [Trans. That doctor is no good…]

I actually heard this comment coming from another doctor. The doctor he was referring to was a specialist that has serviced the community for more than 20 years and has done a ton of charity work. I actually found out that the commenter had a daughter who has graduated with the same specialty as the victim and needed a recommendation of patients to see.

This has got to stop! This is bad practice. This is unethical practice. Medical Doctors are becoming scarce and the remaining Filipino doctors are discriminating each other.

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